Breathing Meds: What You Should Know

Posted on January 12, 2017July 8, 2020

Posted by Dr. Monica Wonnacott | January 12, 2017

This time of year, I am seeing tons of kids with complaints of coughing. Not surprisingly, I am prescribing a lot more inhaled medications to help with those coughs. The trick is knowing when and what to use. Now all coughs do not need inhalers. Furthermore, inhalers are not just prescribed for kids with asthma (although that is the typical reason).

Why would you use an inhaler if you don’t have asthma?

Sometimes after getting a bad respiratory bug/virus, the airways in the lungs will get inflamed. This is sometimes referred to as a “post viral reactive airway disease.” When the airways are inflamed and irritated you get coughing. Inhaled steroids are used to help decrease that inflammation (which indirectly gets rid of the cough). Not all coughs need an inhaler. When your pediatrician listens to your child’s lungs he/she will determine if it sounds like your child has airway inflammation (which often manifests with wheezing).

What is an inhaled steroid?

Inhaled steroids (more correctly, inhaled corticosteroids) are medicines that delivered in an aerosolized from (through an inhaler or nebulizer machine) and go directly to the lungs. Inhaled steroids reduce swelling in the airways. There are a number of inhaled steroids, here are ones commonly used in pediatrics (of note, while I included the generic name of each med, to my knowledge there aren’t any generic inhaled corticosteroids that come in an inhaler-which just means they are expensive medications Examples are:

Fluticasone (tradename Flovent)
Budesonide (tradename Pulmicort)
Beclomethasone dipropionate (tradename QVAR)
Mometasone (Asmanex)
Ciclesonide (Alvesco)

It’s also worth mentioning that there are a number of inhaled corticosteroids that are in combination with long acting bronchodilators. These meds are considered a step up in terms of strength (so used in kids who have more severe asthma or breathing issues). They include medications like Advair, Dulera, and Symbicort.

Inhaled corticosteroids in general are considered “preventative” or “controller” medications. While they are absolutely used when a kid is sick, they are also designed to help with chronic airway inflammation, thereby preventing/controlling asthma symptoms before they are out of control.

How is albuterol different?

Albuterol is NOT an inhaled corticosteroid. Instead, it is a bronchodilator. Which means it relaxes the smooth muscles that go around the airways. When the muscles are tight and constricted, the airways get smaller making it harder to breath. Albuterol is also made by a number of different drug manufacturers. Common names are Ventolin, Proair, and Proventil. Xopenex is related to albuterol chemically (it just has one little change that helps some kids who are prone to problems with albuterol).

When do I use which medication?

Inhaled corticosteroids – Use everyday. They prevent symptoms.
Bronchodilators (e.g., albuterol) – Use as needed. They are rescue inhalers, so it is used as the need arises (e.g., trouble breathing, coughing attack, wheezing).

Does my child need a spacer?

The short answer is yes. Spacers are little plastic tubes that act as a holding chamber for the inhaled medications. The medicine stays in the tube until the child inhales a good breath and takes the medication into his/her lungs. Nearly all inhaled medications should be used with a spacer. There are a few exceptions where the spacer is built into the inhaler (e.g. Aerospan or Pulmicort flexhaler) or the inhaler comes in a form that was designed to eliminate the need for a spacer (e.g. Advairs diskus). Otherwise, the studies show that a good percentage of the medication when used without the spacer, ends up in the mouth, predominately on the tongue, instead of the lungs where it was intended to go. Spacers increase the actual percentage of the medication going to the lungs.

If your child needs an inhaler, make sure you understand what kind of inhaler it is and how to use it. Good luck!

Coughing At Night Or When Running? Think Asthma.

Posted on May 11, 2016July 8, 2020

Posted by Dr. Monica Wonnacott | May 11, 2016

The Asthma and Allergy Foundation of America (AAFA) calls May the National Asthma & Allergy Awareness month because this is the peak season for problems. So it seemed fitting to write about asthma and increase awareness.

Asthma is major health concern in America. Did you know (according to the AAFA)

10 people a day die from asthma
Asthma affects 24 million Americans
3 million children (younger than 18) have asthma

Asthma is chronic disease that causes the airways in the lungs to be inflamed. The inflammation causes the airways to become narrow. Those narrow airways spell trouble whenever the demands on the lungs are increased. Those demands, or “triggers,” make it difficult to breathe when a person has asthma.

Common Asthma triggers

Exercise
Viruses/sickness
Cigarette smoke (both first and secondhand)
Pets
Allergens
Cold air/weather
Molds and dust

If you don’t have asthma, it can be hard to understand what having an attack feels like. Imagine running a mile and only being allowed to breathe through a straw. Pretty quick you would feel terrible. Your head would hurt and you’d feel dizzy (from not getting enough oxygen to your brain). You’d be seriously winded, extremely tired, and your chest would be hurting. Even when someone with asthma is not having an attack, it is common to still be symptomatic.

Asthma Signs and Symptoms

Cough (especially worse at night and first thing in the morning)
Cough with exercise
Wheezing
Shortness of breath
Chest tightness

What Causes Asthma?

The short answer is we don’t exactly know. The longer answer is that science has shown a number of different contributing factors.

There’s a lot of different science to show that early and frequent exposure to certain common allergens and infections decreases the risk of developing asthma. For example, having a pet early in life can decrease the risk of developing asthma, but later the pet can act as a trigger. Coming from a large family or living on a farm is also protective against asthma. Early use of antibiotics in life is also linked to asthma (yet another reason to judiciously use antibiotics). Viruses can both decrease and increase the risk. For example, early exposure to respiratory syncytial virus (RSV) increases the risk.
There is a strong genetic component to developing asthma. There are many specific genes that have been linked to development of asthma. Families that are “atopic,” that is, those with eczema, allergies, and asthma, are also at increased risk. So while one condition (e.g., eczema) doesn’t lead to the other (e.g., asthma), having one, increases the risk of developing another. This phenomenon is often referred to as the “atopic march.”

Ashtma Treatment

There is no cure for asthma. You may have heard of kids “outgrowing asthma.” While not exactly true, the concept is that the lungs continue to grow and develop in the first 6-8 years of life. Many kids, who had trouble when they were toddlers, will get better as their lungs mature. Treatment generally consists of using medications (commonly inhalers) to modify symptoms and avoiding triggers. Inhalers are divided into 2 groups:

Controller inhalers. These medications are used daily to prevent the asthma attack. Generally, these are inhaled steroids.
Rescue inhalers. These medications are used on an as needed basis to deal with symptoms when the asthma has flared.

You will work with your child’s pediatrician to help determine the severity of your child’s asthma. The severity will determine what and how often you’ll be giving your child medication. (As an aside, prep yourself. The medications can be really expensive and unfortunately, there aren’t a lot of generic drugs available).

If you managed to read the entire article, here’s the comical reward for your efforts. Whenever I write an article, I often double check facts (especially if I quote a statistic). I discovered this interesting historical note about asthma. In the 1930s-1950s, asthma was considered one of the “holy seven” psychosomatic illnesses. Asthma was considered psychological and was consequently often treated with psychoanalysis and other talking cures. The “wheeze” (which is really from a constricted/tight airway) was thought to be a suppressed cry of a child for its mother. The treatment of depression was especially important for people with asthma. Isn’t that a riot? If your doctor prescribes Prozac to your child who is having an asthma attack, your doc may be a little too old school. Throw that little historical nugget out at your next dinner party.

It’s Kindergarten Physical Time

Posted on April 6, 2016August 18, 2020

Posted by Dr. Monica Wonnacott | April 6, 2016

It’s springtime, and that means time to register your kids for the upcoming school year. If you have a child that will be in kindergarten come this fall, you’ll need to schedule a Kindergarten Physical. Every state’s requirements are a little different. In Utah, there is a physical form, immunization form, and medication form (if applicable) for your physician to fill out. The physical form allows the school to know if there are any major medical problems they should know about or limitations in a child’s physical abilities (e.g., ability to participate fully in gym). It also has a vision screen as part of the form. The immunization form ensures that a child is up-to-date on shots. Depending on what state you live in, you may or may not be able to opt out of immunizations if you want your child to go to a public/state funded school. The medication form is for school personnel to be able to administer medications (either regularly scheduled or on an emergency basis) to your child. This is particularly necessary for children who have conditions like asthma, serious peanut allergies, seizures, etc.

What to expect during your visit?

Your pediatrician should talk with your child, and in so doing, assess his or her kindergarten readiness. Can your child carry on a conversation? Can your child follow directions? Is your child academically ready (e.g., know letters, count)? There should also be a number of questions relating to your child’s overall health (e.g., diet, sleep, exercise). The visit should include a complete head-to-toe examination (including a vision screen). There should also be a component of what is termed “anticipatory guidance.” This is the helpful teaching your doctor should do with you and your child (e.g., education on media time, car seats, healthy eating, appropriate development). Finally, if your child didn’t get them the year previous (kindergarten shots can be given any time after the age of 4), the visit will end with the vaccinations. As a side note, many offices will also do a blood test at the kindergarten physical to see if your child is anemic. This can be done as a finger poke or a full blood draw. It may be worth knowing ahead of time if your pediatrician’s office does this, so you can prep your child.

Knowing what to expect can make a huge difference in helping the visit go smoother. I can usually tell when a parent has taken the time to walk through with the child what to expect at the visit. The child isn’t bothered by being asked to wear a gown, open his/her mouth, have a light shown in the ears, etc. The only potential backfire is knowledge of the shots. Sometimes knowing that the visit is going to end in shots will cause a child to be more afraid (I get it, shots hurt). While I am a big believer in being honest and upfront with children, if your child is going to freak out for the hours before the visit and all during the visit, you may want to hold on telling him or her about the shots until moments before they happen. You know your child best and will know best how to handle knowledge about that component of the visit.

I love the Kindergarten physical visits in my schedule each day. It’s a great age, the kids are all so different, and it’s fun to see them growing up.